Overdose risk higher for veterans getting opioids from both VA and other places

Matt Saintsing
December 07, 2018 - 1:00 pm

Photo by Jose M. Osorio/Chicago Tribune/TNS

Opioids have long been used to treat pain and for veterans with service-connected ailments like chronic pain, they can be a godsend. But a study published in the American Journal of Managed Care points to a darker reality: veterans filling opioid ‘scripts from multiple sources have a higher likelihood of overdose and even death. 

As far as the VA is concerned, there is no safe dose of opioids, and the risks climb with each increase. But the VA isn’t the only place vets receive medical care these days.

Many use private insurance gained through their jobs or Medicare. And with the expansion of the popular Veterans Choice Program, more are receiving a wide range of healthcare services outside of a VA hospital, an especially attractive option for vets who live in more rural parts of the country. 

 That doesn't’t mean every doctor is in the loop with each other, which can lead to difficulties in coordinating treatments, and that can be deadly. 

Photo by Lacy Atkins / The Tennessean-Nashville

To get a snapshot of the issue of opioid prescriptions on vets, researchers combed through more than 16,800 in Massachusetts who were using such pills over two years. 

Of those, more than half get their opioids through the VA, while 45 percent used both VA and non-VA pharmacies. 

 The differences between these two groups shed light on just how unsafe getting opioids from more than one place can be. 

Just seven percent of veterans who use the VA as their sole opioid provider received “high-dose” opioid therapy, compared to 26 percent for those who got them from more than one place. In other words, VA-only patients are three times less likely to receive a higher dose of a drug that is easily habit forming and often deadly. 

The numbers are even worse when it comes to mixing deadly drug combinations.

Benzodiazepines, or Benzos, are used to treat anxiety, insomnia and alcohol withdrawal. When taken with opioids, Benzos lead to 10 times a higher risk of overdose than just taking opioids alone. 

Eight percent of VA-only patients had both opioid and benzodiazepine prescriptions, a figure that shoots up to 35 percent for patients who used dual care. 

So, what’s the way forward?

The authors note that this study is only in Massachusetts, and with other parts of the country having their own cultures and structural issues, we shouldn't’t paint with such a broad brush. 

However, the researchers do say there are valuable lessons from the study. For one, they recommend more education for veterans and health care providers both in and outside VA. They also suggest a healthy circulation of naloxone, a drug that blocks the impacts of opioids, and if given correctly, has been shown to reverse the effects of an overdose. 

One  thing that’s certain is more coordination in care would go a long way to make opioid treatments safer. That means pharmacies, caseworkers, medical and mental health providers should work more in tandem to decrease any potential opioid abuse. 

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